Provider Demographics
NPI:1255987616
Name:BOBBITT, KATELYN NOELLE (DMD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:NOELLE
Last Name:BOBBITT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 EUBANK BLVD NE APT 1121
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7355
Mailing Address - Country:US
Mailing Address - Phone:479-806-3320
Mailing Address - Fax:
Practice Address - Street 1:950 UNSER BLVD SE STE 100
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6376
Practice Address - Country:US
Practice Address - Phone:505-273-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD5180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist